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MGH Hotline 08.27.10 Administering the correct dosage of insulin to hospitalized patients with type 2 diabetes is a top issue in quality and safety for many hospitals.

MGH grant supports study of electronic insulin-order system

27/Aug/2010

Administering the correct dosage of insulin to hospitalized patients with type 2 diabetes is a top issue in quality and safety for many hospitals. The complexity of care for these patients and the large range of insulin dosages -- anywhere from 10 to more than 100 units a day -- creates significant room for error.

Through the support of a 2008 MGH Clinical Innovation Award, Enrico Cagliero, MD, of the Diabetes Unit and Transplant Center, and several other MGH researchers recently conducted a study analyzing the effectiveness of an electronic template used to order insulin for hospitalized patients with type 2 diabetes. The annual Clinical Innovation Awards, funded by the MGH/MGPO Center for Quality and Safety and administered by the Clinical Research Program, enable clinical researchers like Cagliero to devote 20 percent of their time to projects that may lead to improvements in clinical care.

Researchers in the insulin-order study randomly selected several teams of internal medicine residents on acute general medicine floors. All teams received written and oral instructions on ordering the correct dosage of insulin, but only half of the teams were granted access to the electronic insulin-order template. The template, developed in collaboration with Partners Information Systems (IS), guided providers to order insulin based on factors like the patient's weight and whether or not the patient was eating.

Over the course of two months, researchers measured diabetes care parameters of the 128 participating patients. Data analysis found that use of the electronic template was associated with significantly improved glucose levels in the patients.

"We believe that a 'smarter' template, offering additional guidance, would even further improve care of hospitalized patients with type 2 diabetes," says Cagliero. "Right now we are meeting with Partners IS and MGH leadership to discuss making further improvements to the template and implementing it hospitalwide."

The results of the study will be published in Diabetes Care and were released online in July. Co-authors of the study are Deborah J. Wexler, MD, MSc, and Sean Burns, MD, both of the Diabetes Center, and Peter Shrader, MA, of the Division of General Medicine.